4What is EBM?“The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research.Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B., Richardson, W.S., Evidence based medicine: what it is and what it isn’t. BMJ 312,

5EBM ...Replaced the older term ‘clinical epidemiology’ and synonimous with ‘evidence-based practice’.The ‘evidence’: empirical evidence about what actually works or doesn’t work in practice.EBM is about actual clinical outcomes.

6Why Do We Need EBM? Large info gap: research and clinical practiceOverloaded research informationNot easily accessible for busy practitioner

7Why Do We Need EBM? Bridge of the gap: systematic reviewsSpeciality by speciality

10Steps in EBM Formulate an answerable questionTrack down the best evidence of outcomes availableCritically appraise the evidence (ie find out how good it is)Apply the evidence (integrate the results with clinical expertise and patient values)Evaluate the effectiveness and efficiency of the process (to improve next time)

12Steps in EBM 1. Formulate an answerable questionA 28-year-old male presents with recurrent furunculosis for past 8 months; these episodes have been treated with drainage and several courses of antibiotics but keep recurring. He asks if recurrences can be prevented.

13Steps in EBM 1. Formulate an answerable questionGeorge has come in to your surgery to discuss the possibility of getting a vasectomy.He says he has heard something about vasectomy causing an increase in testicular cancer later in life.You know that the risk of this is low but want to give him a more precise answer.

14Steps in EBM 1. Formulate an answerable questionJeff , a smoker of more than 30 years, has come to see you about something unrelated.You ask him if he is interested in stopping smoking. He tells you he has tried to quit smoking unsuccessfully in the past.A friend of his, however, successfully quit with accupuncture. Should he try it?Other interventions you know about are nicotine replacement therapy and antidepressants.Population/patient?Intervention/indicator ?Comparator/control ?Outcome ?

15Steps in EBM 1. Formulate an answerable questionSusan is expecting her first baby in two months. She has been reading about the potential benefits and harms of giving newborn babies vitamin K injections.She is alarmed by reports that vitamin K injections in newborn babies may cause childhood leukaemia.She asks you if this is true and, if so, what the risk for her baby will be.Population/patient?Intervention/indicator ?Comparator/control ?Outcome ?

36Were the groups of subjects representative and comparable? Steps in EBM 3. Critically appraise the evidence (ie find out how good it is)Were the groups of subjects representative and comparable?Was the outcome measurement accurate?Was a placebo used?Could the results have been due to chance?Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of Pharmaceutical Education, 71 (4) Article 63